Second-generation antipsychotics drive weight gain and metabolic change, and the monitoring that catches it is the step most often skipped once a patient is stable. The schedule is simple and worth protecting.
Record weight or body mass index, waist where feasible, blood pressure, fasting glucose or HbA1c and a lipid profile at baseline. Repeat weight frequently in the first months, recheck glucose and lipids at about three months, then at least yearly. Olanzapine and clozapine carry the highest metabolic burden and deserve the closest watch.
Act on what you find rather than only recording it: reinforce diet and activity early, consider switching to a lower-risk agent where the illness allows, and treat emerging diabetes or dyslipidaemia on its merits. The weight gain that drives long-term cardiometabolic risk happens early, so the first months are where monitoring pays off.
- Check weight or body mass index, blood pressure, fasting glucose or HbA1c and lipids at baseline.
- Recheck weight often in the first months, glucose and lipids at about three months, then at least yearly.
- Watch olanzapine and clozapine most closely, as they carry the highest metabolic burden.
- Act on findings: reinforce lifestyle early, consider a lower-risk agent, and treat diabetes or dyslipidaemia directly.
Why it matters
Most antipsychotic-driven weight gain and metabolic change happen early, so skipping monitoring once a patient is stable misses the window to act.
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